Description: This article will clarify valuation issues for the waiver of premium benefit in Accident and Health products.

Description: At the end of 1963 health insurance claim reserves and liabilities held by companies on this continent totaled well over one billion dollars. This paper seeks to study the problems involved in calculating these reserves and liabilities and to describe the methods in use. From Transactions of Society of Actuaries 1964, Vol. 16, Pt. 1, No. 44 AB.

Description: This is an internal letter from an actuary to an associate regarding a claims study that established, in the mind of the writer, the adequacy and conclusiveness of a small sample size in certain situations. Actuarial Research Clearing House ARCH 1988, Vol. 3

Description: This paper develops a parametric model for health care insurance claims to fit parametric models to the data. Model selection is based on the ChJ-squared goodness-of-fit test and a comparison of the empirical limited expected value function to parametric limited expected value functions. A copula function was used to model the bivariate portion of the data. From Actuarial Research Clearing House 1993, VOL. 3.

Description: This paper describes a process for developing rates for a preferred provider organization [PPO]. From Transactions of Society of Actuaries 1985, Vol. 37.

Description: This research report provides an evaluation and synthesis of the methodologies and data samples used on characterizing health care fraud.

Description: The SOA’s research objective is to provide guidance to state exchange officials and administrators, federal officials and administrators, and actuaries assisting states and health plans. The goal of the project is to estimate the morbidity and/or cost for newly insured individuals in the individual market (and to some degree, the small group exchange) relative to the morbidity and/or cost for the current commercially insured population. This analysis will primarily focus on the individual, non-group market. In order to plan for the impact that these currently uninsured individuals will have on the health insurance markets, it will be important to understand their costs relative to the costs for people already enrolled, for whom many health insurers have experience and data.

Description: This paper examines five alternative valuation methods - prospective, retrospective, global, intermediate, and static - for the proper application of GAAP to Medicare supplement insurance. The focus of this paper is on the changes to expected future claim costs due to changes in the Medicare deductibles.

Description: In practice, the actuary may be required to forgo independent mathematical judgment in order to follow regulations which prescribe specific exposure or enforce counts for full and partial credibility. In this paper the authors give specific examples of such regulation from various states, and discuss the positive and negative features of the regulatory approaches. From Actuarial Research Clearing House, 2003 Vol. 3.

Description: This paper describes a modified development method for analyzing claims experience and calculating claim reserves and liabilities on short-term health insurance benefits. It identifies many of the influences on claim development and discusses various ways to recognize them. From Transactions of Society of Actuaries 1989, Vol. 41.